Healy Ray
Doctoral Researcher, London South Bank University, UK.
J Res Nurs. 2025 Jan 29:17449871241286757. doi: 10.1177/17449871241286757.
To explore how nurses understand and make sense of multiple definitions of nursing practice.
The study used ethnomethodology to explore how nurses in an acute hospital ward shape, construct and sensemake nursing practice in their everyday worlds. Multiple data sources were used to triangulate different constructions of reality and generate a broader understanding, including non-participant shadowing of nurses during eight shifts, semi-structured interviews with six registered nurses and a review of the nursing section of the hospital's Electronic Patient Record system. Data were collected in two surgical wards in an acute hospital (2019-2020). Data were iteratively coded and refined through all stages of the study.
Nurses make sense of conflicting expectations by creating multiple realities which they apply in different situations to structure how they deliver care. This finding suggests that nurses move seamlessly and unknowingly through these created realities, supported by using specific but discrete languages that they can effortlessly adopt. A consequence is that no single model or theory contains all the realities.
This study goes some way to explain the described difference between work-as-imagined and work-as-done. Failure to acknowledge the multiple realities constructed in practice during pre-registration education may explain the theory-practice gap that many new graduates experience and why anticipated outcomes described in research projects might not be realised in everyday practice.
Nursing practice is not governed by a single theory or model, and nurses make pragmatic transitions between different expectations. Recognition of this is critical to effective planning and leadership of the nursing resource. Using electronic records as a single measure of nursing work has the potential to create a bias towards one reality and thereby render other aspects of nursing value invisible. Failure to embrace the totality of nursing practice may impede the delivery of anticipated patient outcomes and system efficiencies.
探讨护士如何理解和领会护理实践的多种定义。
本研究采用常人方法学，以探究急症医院病房的护士如何在其日常工作中塑造、构建护理实践并赋予其意义。使用了多种数据源来对不同的现实构建进行三角验证，并形成更广泛的理解，包括在八个班次中对护士进行非参与式跟踪观察、对六名注册护士进行半结构式访谈，以及对医院电子病历系统中护理部分的审查。数据收集于一家急症医院的两个外科病房（2019 - 2020年）。在研究的各个阶段，数据都经过反复编码和完善。
护士通过创造多种现实来理解相互冲突的期望，他们在不同情况下应用这些现实来构建护理服务的方式。这一发现表明，护士在这些创造出来的现实中不知不觉地无缝穿梭，借助能轻松采用的特定但离散的语言的支持。结果是，没有单一的模型或理论能涵盖所有的现实。
本研究在一定程度上解释了所描述的想象中的工作与实际完成的工作之间的差异。在注册前教育中未能认识到实践中构建的多种现实情况，可能解释了许多新毕业生所经历的理论与实践差距，以及为何研究项目中所描述的预期结果在日常实践中可能无法实现。
护理实践并非由单一理论或模型所支配，护士在不同期望之间进行务实的转换。认识到这一点对于护理资源的有效规划和领导至关重要。将电子记录作为护理工作的单一衡量标准，有可能导致偏向一种现实的偏差，从而使护理价值的其他方面变得不可见。未能全面接受护理实践可能会阻碍预期患者结果的实现和系统效率的提升。
